HomeMy WebLinkAboutBuilding permit appAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
I\�
2-
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR: TOO a-e
PROPOSED IMPROVEMENT LOCATION:
Address:
11,62P MW PkLILbuiv, .123i l V
L L
Property Tax ID #: - -
Lot No.
IA
Site Plan Name: v e
Block No.
Project Name: ?-
DETAILED DESCRIPTION OF WORK:
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit - check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors _ Pond
Electric _ Plumbing _ Sprinklers _ Generator
Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ �� Utilities: —Sewer _Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name C. t
me:
Addre
Q
Umpany:
z
City: State:
Address: �'Uqo 8L
skg�� S-V -
City:
State: FL
Zip Code: Fax:
Phone No. _ E-
I
Zip Code: "� q
Fax:
Maik
Phone No
Fill in fee simple Title Holder on next page (if different
E-Mail 1 am
em .
State or County License
from the Owner listed above)
If value of construction is 2500 or more, a RECORDED Notice of Commencement
is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement
is required.
5A AM
MORTGAGE COMPI
N me
. ..... . . ...
. ... ........ . .......................... .. .
ame, ..........
Address
.... .....
City:
.i.* ..............
Of,
.......
.__......Phonenq:
..,....,...."'
11
......z
FEE SWPLEIITTHOLDER::
ILA'
Not lcabI6. .1
Addressi7.
... ....
.........
. . .......... . .
The fiblidWing building . ' rmit applicationsare
accessory ence
WARNING TO dw a . u , Hailu' r tdil
z
A
LucreCounty bfl-
-d" -, be -,-666z i On drovah"ttti$r-'-D.ft